A female patient with T5 AIS A SCI is pregnant and approaching labor. Her obstetrician contacts the rehabilitation team to discuss risks during delivery. Which complication is this patient at GREATEST risk for during labor?

A female patient with T5 AIS A SCI is pregnant and approaching labor. Her obstetrician contacts the rehabilitation team to discuss risks during delivery. Which complication is this patient at GREATEST risk for during labor?

• A. Orthostatic hypotension
• B. Autonomic dysreflexia
• C. Spinal shock recurrence
• D. Deep vein thrombosis

Answer: (D)

In this scenario, the main idea is that pregnancy with a high-level spinal cord injury dramatically increases the risk of venous thromboembolism. Pregnancy already shifts the body toward a hypercoagulable state, and spinal cord injury, especially with little or no motor activity below the injury, causes venous stasis in the legs because the muscle pump is diminished and blood return is impaired. During labor, immobility and pelvic venous compression further amplify this stasis, making clot formation in the deep veins much more likely. That combination—pregnancy plus SCI leading to venous pooling and reduced mobility—makes deep vein thrombosis the most probable complication to arise during the labor window. Autonomic dysreflexia is a serious concern for injuries at or above T6 and must be anticipated, but the question focuses on which complication is most likely to occur acutely during labor, and DVT best fits that scenario. Spinal shock recurrence is unlikely in someone with a long-standing AIS A injury, and orthostatic hypotension is not the principal risk during active labor.

In this scenario, the main idea is that pregnancy with a high-level spinal cord injury dramatically increases the risk of venous thromboembolism. Pregnancy already shifts the body toward a hypercoagulable state, and spinal cord injury, especially with little or no motor activity below the injury, causes venous stasis in the legs because the muscle pump is diminished and blood return is impaired. During labor, immobility and pelvic venous compression further amplify this stasis, making clot formation in the deep veins much more likely. That combination—pregnancy plus SCI leading to venous pooling and reduced mobility—makes deep vein thrombosis the most probable complication to arise during the labor window. Autonomic dysreflexia is a serious concern for injuries at or above T6 and must be anticipated, but the question focuses on which complication is most likely to occur acutely during labor, and DVT best fits that scenario. Spinal shock recurrence is unlikely in someone with a long-standing AIS A injury, and orthostatic hypotension is not the principal risk during active labor.